To assess whether the use of large stents is justified, we have retrospectively reviewed the results of 8 French gauge (FG) stents with pigtails and 10 FG straight stents in the palliation of biliary obstruction due to malignancy. The incidence of cholangitis following stent insertion was significantly lower with 10 FG stents, 3 (5%), compared with 8 FG stents, 13 (34%), p less than 0.001, chi 2. Stent survival until blockage was significantly longer for 10 FG (median 32 weeks) compared with 8 FG (median 12 weeks), p less than 0.001, log-rank. The superior performance of the 10 FG stents was due to their larger diameter which gives them a flow capacity much greater than the physiological bile flow. We recommend that stents of at least 10 FG diameter are used for the endoscopic palliation of biliary obstruction due to malignancy.